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SAN JOAQUIN COUNTY �. <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL:(D II III PHS-EH LOG # <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> Original Source: Telephone: QC 0 <br /> Reporting Agency Nam — <br /> Agency Contact: Te ephone: <br /> Address: <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: Ze -- � �_ %p � <br /> (Best Physical De(cription) (City or County <br /> Date of Discharge: <br /> Date Nutttteu: o -/y - 6 % tune: 0 (� / <br /> L . <br /> D. RESPONSIBLE PERSONBUSINESS <br /> Name of Business <br /> Contact Person- Telephone: <br /> Physical Address: <br /> E. DESCRIPTION <br /> Type Release: <br /> Volume: Z <br /> Chemicals: <br /> 1 . ACT ON TAKEN <br /> EI-1 VOeV,;;�'.�1/ ��L�. <br />